Reimbursement & Eligibility
REIMBURSEMENT: WHO PAYS FOR HOSPICE?
Medicare, Arizona Long-Term Care System (ALTCS), most AHCCCS plans and nearly all private insurance plans have a hospice benefit that covers costs associated with hospice care.
Beneficiaries who elect the Medicare hospice benefit agree to forego curative treatment for their terminal condition. For conditions unrelated to their terminal diagnosis, Medicare and other payors continue to cover items and services outside of hospice. For example, a hospice patient who is injured in a fall could go to his personal physician for treatment, and the physician would be reimbursed for care.
The hospice benefit provides pain relief, comfort, emotional and spiritual support. Our services include:
- Homes visits by the hospice team, including:
- a physician or nurse practitioner
- nurse’s aide
- social worker
- bereavement counselor
- Medications related to the hospice diagnosis.
- Medical equipment and supplies.
- Respite care, which allows the patient to go to a palliative care unit or nursing home for a short period so the family caregiver can take a break.
Medicare pays hospices a daily flat rate for each day a beneficiary is served. The payment rates are set for four categories: routine home care, continuous home care, inpatient respite care and general inpatient care. About 95 percent of days of hospice care provided are at the routine home care level, according to Medicare.
Because Hospice of the Valley is not-for-profit, no one is denied service because they lack insurance or financial means.
ELIGIBILITY: WHEN TO CONSIDER HOSPICE CARE?
It is time to consider hospice care when a patient exhibits one or more of the following:
- Patient/family chooses comfort care
- Loss of function/physical decline
- Increase in hospitalizations
- Dependence in most activities of daily living
- Multiple co-morbidities
- Increase in ER visits
- Weight loss
Here are indicators based on specific diseases—cancer, heart disease and many other conditions.